Mental health and the Imago Dei

Dr Janet Warren is a theologian and physician who practices psychotherapy, and has guest lectured at London School of Theology as part of the Science for Seminaries programme

My psychotherapy patients often exemplify human complexity and creativity. Some coped with horrendous childhood abuse by splitting into different parts, each with a unique role—functioning in the world, bearing anger, remaining a child, holding onto hope. I have often wondered: is this a sickness (classified as dissociative identity disorder in the medical community) or is it a clever way of surviving an unbearable situation? It turns out I’m not alone.

The medical model of mental ‘illness’, which assumes psychological problems have an organic cause and primarily uses psychopharmaceuticals, is widely accepted. The popular press lauds the explanatory power of neuroscience (‘neuromania’) and the curative power of medication (‘pharmacomania’). The Christian community, though often offering compassion to those suffering, has tended to follow secular views, perhaps moving from sin to sickness as causative factors and from “just pray” to “just take a pill” as solutions to mental maladies. Indeed, the medical model has been helpful in destigmatizing mental suffering and improving the lives of those afflicted.

However, as critics point out, there are no biological tests that can diagnose mental illness; the concept of a ‘chemical imbalance’ is a myth. Medications have side effects and limited effectiveness. The medical model is reductionistic, assuming homogeneity and ignoring environmental, social, and psychological factors. Diagnosis is subjective, dependent on clinical consensus. Labelling people may lead to false dichotomies between ‘ill’ and ‘well’, and decreased personal responsibility for behaviour, which may preclude healing.

To be fair, broader approaches are often adopted, such as encouraging lifestyle changes and psychotherapy as well as attending to sociocultural factors. And there are alternate views, such as the diathesis-stress model, which suggests that psychological problems result from a combination of predisposing vulnerability and traumatic experience. But the medical model is still very influential.

As Christians called to understand and care for our messy world, this issue is important and broader than simply showing compassion. We need to avoid extremes of either dismissing the problem entirely or uncritically accepting secular understandings of mental health. We need a solid biblical framework. I suggest that of the Christian concept of the imago Dei (Gen 1:26).

Being made in the image of God is both a gift and a responsibility. Humans are bestowed with immense value and dignity, and created with magnificent complexity and diversity. Thus, conditions such as ADHD may represent variation rather than disorder. Many unpleasant emotions are part of God’s good creation, and some of us are more sensitive than others. Humans also have innate capacities and responsibilities to relate to God and others, and to care for ourselves (good sleep, nutrition and exercise can prevent and treat many maladies) and others. We are not passive sufferers, as medical models imply, but have social and moral responsibility, though our choices may be limited by our contexts. However, we experience discomfort because we are born into a world of uncertainty and must navigate the tension between freedom and finitude (known in philosophy as existential anxiety). This seems like a set-up for mental health struggles.

Indeed, humans often make poor choices. We deal with our insecurities through self-exaltation (think narcissism) or self-abnegation (think low self-esteem and depression). We attempt to escape stress and pain through addictions, depression, anxiety, perfectionism etc. We fail to be responsible image-bearers in that our thoughts and emotions are distorted, and our relationships dysfunctional. We fail to care for ourselves and others, which of course compounds psychological problems. Note that the concept of sin is complex; many thoughts and behaviours are subconscious or a result of being sinned against.

Fortunately, our ability to image God is restored through salvation and grace. Minds are renewed, hearts purified, and relationships reconciled. We are realigned to fulfill our vocations. Being transformed into the image of Christ (2 Cor 3:18) is a gradual process but, through the power of the Holy Spirit, we can grow spiritually and exercise responsible stewardship. Indeed, true mental health/flourishing can be viewed as recovering our identity as image bearers.

This perspective (admittedly broad) can inform our interactions with those afflicted with mental health challenges. We should be aware of our assumptions and avoid oversimplification, using multiple lenses—medical, social, psychological, and spiritual. We can learn to embrace ambiguity, uncertainty, and vulnerability. With wisdom, compassion, and discernment, we can help people recognize and accept some created aspects of themselves, especially their value, while simultaneously uncovering obstacles to healthy functioning and reorienting creatures towards their Creator. We may be faultless with respect to the cause of our problems but are responsible for dealing with them. We need to balance acceptance, responsibility to change, and openness to divine healing.

Being made in the divine image is both an awesome gift and a sobering responsibility. This framework can guide a Christian understanding of mental affliction—a complex combination of biological predisposition, creational diversity, and self-centeredness—and our response to it: compassion but challenge, grace but growth, and love with limits.